Methods, devices and systems for forming magnetic anastomoses

ABSTRACT

Methods, devices and systems for forming magnetic anastomoses between two blood vessels. A first anastomotic component is removably supported by the distal end of a delivery device for attachment to a first vessel. The delivery device also supports a second anastomotic component that has been secured to a second blood vessel. The device is operated to secure the first component to the first vessel, couple the second component to the first component, and then release the components to complete the anastomosis. A robotic anastomosis system includes several robotic instruments that may be positioned through ports in a patient, used to secure an anastomotic component to a vessel, and then used to magnetically couple the components. Delivery devices for deploying magnetic anastomotic components include an actuator that uses magnetic repulsion to move the components into engagement with the inner and outer surfaces of the vessel wall. The anastomotic components are secured to the vessel wall by magnetic force and in addition may be secured by mechanical attachment.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims priority under 35 USC §119(e) fromprovisional application Ser. No. 60/323,923, filed Sep. 15, 2001. Thisapplication also claims priority under 35 USC §120 from the followingapplications: application Ser. No. 10/022,187, filed Dec. 13, 2001,application Ser. No. 09/915,226, filed Jul. 23, 2001, application Ser.No. 09/851,400, filed May 7, 2001, application Ser. No. 09/638,805,filed Aug. 12, 2000, and application Ser. No. 09/562,599, filed Apr. 29,2000, now U.S. Pat. No. 6,352,543. The entire disclosure of each of theabove-referenced patent applications is expressly incorporated herein byreference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention relates to forming an anastomoses between hollowanatomical structures or bodies, such as blood vessels, and moreparticularly, to using magnetism to form such anastomoses.

2. Description of Related Art

Many anastomotic couplings have been proposed as substitutes for aconventional, handsewn sutured anastomosis; they have had limitedsuccess. Such couplings are used to attach various hollow structures inthe body, including blood vessels. In the vascular field, most of theproposed couplers or connectors have failed to duplicate the success ofsutured anastomoses and, as such, have not been widely used or accepted.

Among the drawbacks associated with proposed anastomotic couplers arefailure to achieve an acceptable patency rate, insecure or inadequateattachment of the coupler to the vessels, and the inability to produce agood anastomosis on a repeated basis.

Accordingly, there is a need in the art for methods and devices forforming a non-sutured anastomosis between hollow bodies in a quick, easyand repeatable manner.

SUMMARY OF THE INVENTION

According to one embodiment, the invention provides a method for formingan anastomosis between first and second hollow bodies using magneticforce. The method includes steps of providing first and secondanastomotic components that are magnetically attracted to each other andare configured to be secured to first and second hollow bodies. Thefirst component is mounted on a delivery device while the secondanastomotic component is secured to the second hollow body and thenmounted on the delivery device. The first anastomotic component issecured to the first hollow body, and magnetism is used to couple thefirst and second anastomotic components and form an anastomosis betweenthe first and second hollow bodies.

Another embodiment provides a method for coupling first and secondmagnetically attracted anastomotic components mounted on a deliverydevice and includes steps of providing a delivery device configured tosupport the anastomotic components, mounting the first component on thedelivery device, and mounting the second component on the deliverydevice in a first position. The second component is moved to a secondposition and magnetism is used to couple the components.

Another embodiment provides a method for bypassing a portion of a bloodvessel using magnetism. The method has steps of providing first andsecond anastomotic components that are magnetically attracted,respectively, to third and fourth anastomotic components, providing agraft vessel having a proximal portion adapted to be secured to a sourceof blood and a distal portion adapted to be secured to a target vesselso as to bypass a portion of the target vessel. Additional steps includesecuring the first anastomotic component to the proximal portion of thegraft vessel, securing the second anastomotic component to the distalportion of the graft vessel, securing the third anastomotic component toa source of blood and securing the fourth anastomotic component to thetarget vessel at a location distal to the portion to be bypassed.Further steps include using magnetism to couple the first and thirdanastomotic components together and form a proximal anastomosis, afterusing magnetism to couple the second and fourth anastomotic componentstogether to form a distal anastomosis.

Another embodiment provides a method for forming an anastomosis betweenfirst and second hollow bodies using magnetic force and includes stepsof positioning a first anastomotic component on a delivery device, thefirst anastomotic component adapted to be secured to a first hollowbody, positioning a second anastomotic component on the delivery device,the second anastomotic component adapted to be secured to a secondhollow body, wherein the first and second anastomotic components aremagnetically attracted to each other and are positioned on the deliverydevice in an offset configuration with respect to one another.Additional steps include securing the second anastomotic component to asecond hollow body so as to place the opening of the second component incommunication with the second hollow body, moving the first and secondanastomotic components from the offset configuration into substantialalignment with each other, and using magnetism to couple the first andsecond anastomotic components and form an anastomosis between the firstand second hollow bodies.

Another embodiment of the invention provides a system for forming amagnetic anastomosis between first and second hollow bodies. The systemincludes a delivery device and first and second anastomotic componentsthat are magnetically attracted to one another, the components beingmounted on the delivery device in a first orientation, preferably inalignment with each other. A transfer member moves at least one of thefirst and second anastomotic components to place the components in asecond relative orientation in which they are aligned.

Still another embodiment of the invention provides a system for forminga magnetic anastomosis between first and second hollow bodies. Thesystem includes a delivery device and first and second anastomoticcomponents that are magnetically attracted to one another. The first andsecond anastomotic components are supported by the delivery device so asto be physically unconnected, and an actuator is used to deliver thefirst and second components and create a magnetic anastomosis betweenthe two hollow bodies.

Another embodiment of the invention provides a method using robotics toform a magnetic anastomosis between first and second hollow bodies. Themethod includes steps of providing first and second anastomoticcomponents respectively configured to be secured to first and secondhollow bodies, the first and second components being magneticallyattracted to one another, using a robotic element to secure the firstanastomotic component to the first hollow body, using a robotic elementto secure the second anastomotic component to the second hollow body,and coupling the first and second anastomotic components via magneticforce to form an anastomosis between the first and second hollow bodies.

Still another embodiment of the invention provides a robotic system forforming an anastomosis between first and second hollow bodies usingmagnetic force. The system includes multiple robotic elements configuredto removably support first and second anastomotic componentsrespectively configured to be secured to first and second hollow bodies,the first and second components being magnetically attracted to oneanother. The first and second anastomotic components are supported bythe robotic elements and a user may operate the robotic system tomanipulate the robotic elements to secure the first and secondanastomotic components to the first and second hollow bodies,respectively, and magnetically couple the first and second anastomoticcomponents and form an anastomosis.

Yet another embodiment of the invention provides a method for couplingfirst and second magnetically attracted anastomotic components that aremounted on a delivery device and includes steps of providing at leastfirst and second anastomotic components configured to be secured to afirst hollow body, the first and second components being magneticallyattracted to one another, providing a delivery device configured tosupport at least two anastomotic components, mounting the firstanastomotic component on the delivery device, mounting the secondanastomotic component on the delivery device, and using magneticrepulsion between a portion of the delivery device and the firstanastomotic component to move it toward the second anastomoticcomponent.

Another embodiment of the invention provides a delivery device fordelivering at least one magnetic anastomotic component to form ananastomosis between first and second hollow bodies. The delivery deviceis configured to support an anastomotic component, and the anastomoticcomponent includes at least two members magnetically attracted to oneanother. The two members of the anastomotic component are supported bythe delivery device, and the delivery device includes an actuator thatuses magnetic repulsion to move one of the members toward the othermember.

BRIEF DESCRIPTION OF THE DRAWING FIGURES

FIG. 1A is a side elevation view of a delivery device constructedaccording to one embodiment of the invention;

FIG. 1B is an upper plan view of the delivery device shown in FIG. 1A;

FIG. 2A is a side elevation view of the delivery device shown in FIG. 1Awith the nose cone of the device in an extended position;

FIG. 2B is an upper plan view of the delivery device shown in FIG. 2A;

FIG. 2C is an upper plan view of the delivery device shown in FIGS. 2Aand 2B with a cutting tip extending from the nose cone;

FIG. 3 is a perspective exploded view of a cradle disposed at the distalend of the delivery device;

FIGS. 4A, 4B and 4C are, respectively, upper plan, side elevation, andend elevation assembly views of the cradle shown in FIG. 3;

FIG. 5 is an upper plan view of a magnetic anastomotic componentconstructed according to one embodiment of the invention;

FIGS. 6A through 6G are sequential perspective views of the distal endof the delivery device being used to couple first and second anastomoticcomponents to form an anastomosis between first and second vessels;

FIGS. 7A through 7D are bottom plan views sequentially showing thedelivery device being used to secure a first anastomotic component to afirst vessel and then couple the first component to a second anastomoticcomponent which is secured to a second vessel;

FIGS. 8A through 8D are side elevation views corresponding to FIGS.7A-7D but showing a first vessel to which the first anastomoticcomponent is being secured;

FIGS. 9A through 9F are perspective views sequentially showing the useof a robotic system to form a magnetic anastomosis according to anotherembodiment of the invention;

FIGS. 10A and 10B are perspective views of a delivery device constructedaccording to an alternative embodiment of the invention, wherein ananastomotic component is shown mounted on the delivery device prior toactuation of the device;

FIGS. 11A and 11B are, respectively, fragmentary side and end elevationviews of the device and anastomotic component illustrated in FIGS. 10Aand 10B;

FIGS. 12A and 12B are, respectively, fragmentary side and end elevationviews of the device and anastomotic component illustrated in FIGS. 11Aand 11B after partial actuation of the device;

FIGS. 13A and 13B are, respectively, fragmentary side and end elevationviews of the device and anastomotic component illustrated in FIGS. 12Aand 12B after further actuation of the device; and

FIGS. 14A and 14B are side elevation views in section showing anexemplary actuator for the delivery device shown in FIG. 10A throughFIG. 13B.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

FIG. 1 shows an anastomotic delivery device 10 having a handle 12, firstand second actuators 14, 16, and a shaft 18. The distal end of thedelivery device 10 is indicated by the reference numeral 20 and isconstructed to deploy a first anastomotic component that is configuredto be coupled to a second anastomotic component, thereby forming amagnetic anastomosis. As used herein, the term anastomosis encompassesthe connection of any two (or more) hollow anatomical structures,bodies, vessels, etc.

The distal end 20 of delivery device 10 is used to secure a firstanastomotic component to a first vessel while supporting a secondanastomotic component secured to a second vessel (the components andvessels not being shown in FIGS. 1A and 1B and 2A-2C). In theillustrated embodiment the distal end 20 includes a cradle 22, which isdescribed in detail below with reference to FIGS. 3 and 4A-4C. Thecradle 22 receives the second anastomotic component and a portion of thevessel to which it is attached. The delivery device 10 is used to securethe first anastomotic component to its vessel as well as magneticallycouple the first and second anastomotic components to form theanastomosis.

The delivery device 10 preferably is pistol-shaped as shown, but couldtake alternative configurations. The first actuator 14 preferably has asafety 24 and is operably coupled to the shaft to effect distal andproximal motion of the shaft (i.e., to the left and right in FIG. 1A,respectively). The second actuator 16 is used to operate a tissuepenetrating mechanism which, in the illustrated embodiment, comprises ashaft 26 with a cutting tip 28 at its distal end. The shaft 26 is springloaded so that pressing the second actuator 16 exposes the cutting tip28 by moving it beyond a nose cone 30. FIGS. 2B and 2C show,respectively, the cutting tip 28 in a retracted position and anextended, tissue cutting position.

FIG. 3 is an exploded view of the cradle 22 of the delivery device 10.The cradle 22 includes a base 32, which may be somewhat U-shaped so asto define a space 34 along its one side. The base 32 has a bore 36 towhich shaft 18 is secured, as well as a bore 38 through which an innershaft (not shown) extends. The inner shaft (FIG. 6A) is preferablyprovided with an exterior configured to be complimentary to ananastomotic component (not shown) mounted thereon. The base 32 includestwo ledges 40 that, along with a wall 42, partially define the space 34.The ledges 40 support a transfer member 44 that is used to align and,according to the preferred embodiment, couple magnetic anastomoticcomponents.

The transfer member 44 is preferably a thin sheet sized to rest on theledges 40 of the base 32. When positioned on the base 32 the transfermember 44 overlies a gap 46 located between the ledges 40. While thetransfer member 44 could be formed as part of the base, in theillustrated embodiment it is a separate element that is held in positionby a clamp 48. The clamp 48 is generally L-shaped with a pair ofhorizontal legs 50 adapted to overlie the ledges 40 of the base 32. Asshown, the legs 50 define a gap that overlies the gap 46 of the base 32when the clamp 48 is attached thereto, which leaves the transfer member44 uncovered in that area. The clamp 48 also has a vertical leg 52adapted to be secured to the wall 42 of the base 32 by any suitablemeans, for example, mating apertures 54, 56 and fasteners (not shown).

FIGS. 4A, 4B and 4C show the cradle 22 with the transfer member 44 andclamp 48 attached thereto. The base 32 is configured to support ananastomotic component (not shown in FIGS. 4A-4C) while it is beingsecured to a target vessel. The base 32 has slots 58 (FIGS. 3 and 4A)which receive an anastomotic component in removable fashion.

FIG. 5 shows one preferred anastomotic component constructed accordingto the invention and suitable for use in forming a magnetic anastomosis.The anastomotic component 60 includes an annular base 62, a magnet 64with an opening 66 mounted on the base, and a vessel attaching mechanism68. The base 62 also has tabs 70 sized to be slidably received in theslots 58 of the cradle 22. The tabs 70 are slid into the slots 58 untilthe opening 66 of the component 60 is aligned with the bores 36, 38 ofthe delivery device 10.

The magnet 64 may be attached to the base 62 of the anastomoticcomponent 60 in any suitable manner, for example, adhesively, mechanicallocking, etc. In the illustrated embodiment, the base 62 has lockingtabs 72 for engaging and locking the magnet 64. It will be appreciatedthat the specific construction of the anastomotic component may bevaried from that illustrated. It will also be recognized that theanastomotic component could be removably mounted on the delivery devicein manners other than described herein.

An important feature of the illustrated anastomotic component 60facilitates improved attachment to vessels. In particular, it isdesirable in some cases to use a component with an elliptical profile.The anastomotic component 60 achieves equal spacing at the tips 76 ofthe members 74, which requires unequal spacing of the opposite ends ofthe members, as shown in FIG. 5. The equally spaced tips provideincreased holding force and improved sealing, as compared to a pluralityof arms that are unequally spaced at their tips. This is particularlytrue for attachment members or arms that rely on their distal tips, asopposed to their entire length, to engage tissue.

An exemplary application for the invention will be described withreference to FIGS. 6A through 6G, wherein the delivery device 10 is usedto deploy a first anastomotic component and then magnetically couple itto a second anastomotic component thereto. FIG. 6A shows theabove-described distal end 20 of delivery device 10 positioned alongsidethe above-described magnetic anastomotic component 60 (FIG. 5). The tabs70 of the component 60 are positioned adjacent the slots 58 in the base32 of cradle 22.

The vessel attaching mechanism 68 of the anastomotic component 60 isshown in FIG. 6A in a collapsed orientation for loading onto thedelivery device 10. The illustrated mechanism 68 includes a plurality oftissue engaging members 74 which are designed to move to an expandedorientation in order secure the anastomotic component 60 to a targetvessel (omitted for clarity).

FIG. 6B shows anastomotic component 60 after the tabs 70 thereof havebeen fully inserted into slots 58, which aligns the opening 66 of magnet64 with the shaft 18. The shaft 18 is moved distally until the nose cone30 has cleared the tips 76 of the tissue engaging members 74, and thenit is retracted to capture the tips 76 within a recess 78 formed in thenose cone 30. This holds the tissue engaging, mechanism 68 in itscollapsed orientation with the members 74 radially retracted. Theactuator 14 is preferably constructed so that a single motion causes thenose cone 30 to move distally and then proximally through the component.

FIG. 6C shows a vessel V2 positioned adjacent the cradle 22 and thefirst anastomotic component 60 (which is in the same positionillustrated in FIG. 6B). The vessel V2 has secured thereto a secondanastomotic component 80 comprising magnetically attracted rings 82, 84.The rings 82, 84 are respectively positioned on the inner and outersurfaces of the vessel V2 so as to sandwich the vessel wall 86therebetween. It should be noted that while the second anastomoticcomponent 80 is shown secured to a side wall of the vessel V2, it couldinstead be secured to the end of the vessel V2, for example, by passingthe vessel end through one ring, everting it around over that ring, andthen positioning the other ring against the everted tissue, withmagnetic attraction securing the rings to the vessel.

FIG. 6D shows the vessel V2 positioned in the space 34 defined by thecradle 22 with the second anastomotic component 80 located adjacent thetransfer member 44. The outer ring 84 of component 80 is disposed on thetransfer member 44 and sits between the ledges 40 of the base 32 (whichdefine an elliptical area to receive the elliptical magnet ring). Thetransfer member 44 may be formed of various materials, but preferably ismagnetic or ferromagnetic so that it is attracted to the magneticanastomotic component. This magnetic attraction is used to properlyorient the second anastomotic component 80 on the delivery device 10and, according to another aspect of the invention, to move the component80 into alignment with the first anastomotic component.

FIG. 6E shows the device 10 after the nose cone 30 has been moveddistally to release the tissue engaging members 74 of mechanism 68, asindicated by the arrows. The nose cone 30 is then moved proximallythrough the opening 66 of the magnet 64, as shown in FIG. 6F. Next, thecradle 22 is moved in the direction of the arrows, which moves thetransfer member 44 (and the second anastomotic component 80 heldthereby) toward the first anastomotic component 60. It should be notedthat the cradle, rather than being square or rectangular, could be roundso as to allow movement in multiple directions with respect to theanastomotic components.

Once the second anastomotic component 80 has been moved by the transfermember and is aligned with the first anastomotic component 60, thetransfer member 44 is moved further in the direction of the arrows. Thismotion slides the transfer member 44 from in between the two components,which allows the components to become magnetically coupled. Morespecifically, although the second anastomotic component 80 ismagnetically held against the transfer member 44, its attraction to thefirst component 60 is much stronger. As a result, the transfer member 44releases the second anastomotic component 80, which leaves thecomponents 60, 80 in face-to-face contact, as shown in FIG. 6G. FIG. 6Gshows the tissue engaging members 74 in their expanded position, inwhich they cooperate with the component base 62 to compress the targetvessel tissue (omitted for clarity) and secure the first anastomoticcomponent 60 thereto.

FIGS. 7A-7D are bottom plan views sequentially illustrating the members74 of the first anastomotic component 60 being expanded, the transfermember 44 being used to move the outer ring 84 of the second anastomoticcomponent 80 into alignment with the magnet 64 of the component 60, andthe transfer member 44 being slid from between the two anastomoticcomponents. When the tabs 70 clear the slots 58 the transfer member 44should be moved from beneath the component 80, which ensures that thedelivery device 10 will not be pulled away and lift the component 80from the component 60.

FIGS. 8A-8D are sectional views corresponding to FIGS. 7A-7D, butshowing a first vessel V1 to which the first anastomotic component 60 isbeing secured. (The second vessel V2 is omitted from these views forclarity.) FIGS. 8C and 8D illustrate another aspect of the inventionwherein the opening extending into the vessel V defined by theanastomotic component 60 is sealed during alignment of the components.

FIG. 8C shows the transfer member 44 partially over the opening 66 ofcomponent 60 (with the shaft and nose cone over the rest of theopening). In this position, blood is blocked by the transfer member 44,although some blood may enter the bore that receives shaft 18. The bloodcould be blocked instead, or a flashback lumen could be provided ifdesired. FIG. 8D shows the transfer member 44 after it has been furthermoved to align the first and second anastomotic components 60, 80. Inthis position, the transfer member 44 is disposed between the components60, 80 and blocks blood flow out of the vessel V2. From the position ofFIG. 8D the transfer member 44 is slid out to couple the components 60,80.

According to another embodiment of the invention, a robotic system isused to form a magnetic anastomosis. Referring to FIGS. 9A-9F, adelivery device 90 is schematically shown and has mounted thereon ananastomotic component 92. A pair of robotic elements 94, 96 is providedwith one or more jaw or pincer mechanisms. FIG. 9A shows robotic element94 stabilizing a target vessel V1 (for example, a coronary artery) whilethe element 96 holds the delivery device 90.

As shown, an incision or other opening has been formed in the vesselwall, either by robotics or manually. The opening is sized to receivethe distal end of the delivery device 90 and the anastomotic component92, as shown in FIG. 9B. (The robotic element holding the deliverydevice is omitted from FIGS. 9C and 9D for clarity.) FIG. 9C shows theanastomotic component 92 located in the lumen of the vessel V1 whileanother anastomotic component 98 is moved toward the vessel wall. Anactuator 100 moves the anastomotic component 98 toward the component 92until magnetic attraction causes the two components to sandwich the wallof vessel V1. The actuator 100 may be moved manually or by one of therobotic elements.

FIG. 9D shows the delivery device 90 being subsequently removed and theresulting port that is formed in the vessel V1. The delivery device 90is provided with a mechanism (not shown) that it actuated to release theanastomotic components once they have been secured to the vessel andcoupled to place the vessels in fluid communication. The delivery device90 may have a component release mechanism constructed according to theteachings of abovementioned application Ser. No. 09/638,805, the subjectmatter of which has been incorporated by reference herein.

FIG. 9E shows another pair of robotic elements 102, 104 being used toapproximate a second vessel V2 with the first vessel V1, the latterhaving a magnetic port formed by an anastomotic component 106.Approximating the vessels V1, V2 brings the anastomotic components 98,106 toward each other until they are coupled by magnetic attraction toform the anastomosis, as shown in FIG. 9F.

It should be recognized that practicing this embodiment of the inventiondoes not require the use of a specialized robotic system. To thecontrary, any suitable robotic system may be used, for example, one ofthe known computerized surgical systems for performing various medicalprocedures. Those skilled in the art will nonetheless appreciate that insome applications it may be desirable or necessary to adapt an availablerobotic system for use with the delivery devices and anastomoticcomponents of the present invention.

For example, in the embodiment of FIGS. 9A through 9F, the deliverydevice 90 is held by the end effector (pincer jaws) of the roboticelement 96. Alternatively, the delivery device of the invention may beformed as an integral part of the robotic element, for example, the endeffector of the robotic element may be in the form of an anastomoticdelivery device. The robotic elements may include, in addition to adelivery device, pincer jaws, graspers or other known structure forholding, manipulating and actuating the delivery device. Finally, ratherthan forming a portion of the robotic element as the delivery device,one or more selected features of an inventive delivery device could beincluded in an otherwise conventional robotic element.

It should also be recognized that the number and type of functionsperformed by the robotic elements may vary from procedure to procedure.In the embodiment of FIGS. 9A though 9F, the robotic elements are firstused to position and actuate the delivery device to secure eachanastomotic component to its vessel. Next, the robotic elements are usedto grasp and approximate the vessels and couple the components tocomplete the anastomosis.

The anastomosis could alternatively be carried out without using therobotic system to perform each step of the procedure. For example, therobotic elements may be used to hold and position, but not actuate, thedelivery devices. As an example, a minimally invasive procedure may becarried out using several robotic elements inserted through small portsin the patient to hold the delivery devices in the desired position. Thesurgeon could then actuate a delivery device without using robotics, forinstance, by passing pass the shaft of a remotely-operated instrument(such as a cable-actuated device of the type used in laparoscopicsurgery) through a port to a position adjacent the delivery device. Thesurgeon could then operate the instrument from outside the patient'sbody to actuate the delivery device and deploy the anastomoticcomponents.

As noted above, it should be appreciated that the delivery deviceillustrated in FIGS. 9A through 9F is an exemplary embodiment andrepresents only one possible means for practicing the invention. FIGS.10A through 13B show a delivery device, designated by reference numeral110, which is constructed according to another embodiment of theinvention. The delivery device 110 is configured to be used in a roboticprocedure and has a small profile to permit use in a minimally invasiveprocedure. The relatively small size of the delivery device 110 permitsit to be introduced into a patient's body through a small incision orport unlike devices designed for use in more open surgical procedures.Although the delivery device 110 is constructed to be held by a roboticelement such as that shown in FIGS. 9A through 9F, it may also be usedwith a manually operated surgical instrument.

Referring to FIGS. 10A and 10B, the delivery device 110 comprises a body112 having upper and lower portions 114, 116 configured to support,respectively, first and second anastomotic components 118, 120. Thedelivery device 110 has an actuator 122 which deploys and then releasesthe components 118, 120. The upper portion 114 of the delivery device110 is provided with a retainer 124 that holds the anastomotic component118 until the component 120 has been properly positioned with respect tothe opening in the vessel. Next, the actuator 122 is used to release thefirst component 118 from the retainer 124 and allow it to be coupled tothe second component 120. The second component 120 is held on thedelivery device 110 by a retainer 126 located on the lower portion 116of the body 112. Further actuation of the actuator 122 releases thesecond component 120 (as well as the first component 118 coupledthereto) from the retainer 126 to remove the delivery device.

FIGS. 10A, 10B, 11A and 11B show the delivery device 110 prior toactuation with the anastomotic components 118, 120 being held in placeby the retainers 124, 126, respectively. The body 112 has a bore 128 inwhich a plunger 130 is slidably received, the plunger having theretainer 126 at its distal end. A spring 132 biases the plunger in aproximal direction which forces a pair of tabs 134 of retainer 124 awayfrom the upper portion 114 of the device body 112. In this position thetabs 134 contact the lower surface of the first anastomotic component118 and hold it away from the second component 120.

The actuator 122 is depressed to move the plunger 130 distally, whichcauses the tabs 134 to retract into the body 112 of the delivery device110. As a result, the first anastomotic component 118 is no longerretained as it is in FIGS. 11A and 11B, but rather is free to be movedto a coupling position. In a preferred embodiment the delivery deviceutilizes magnetic repulsion to couple the anastomotic components.

The illustrated delivery device 110 includes an annular magnet 135mounted on the upper portion 114 of the device body 112 adjacent thefirst anastomotic component 118. The magnet 135 is preferably apermanent magnet that is oriented on the device body to have the samepolarity as the adjacent anastomotic component 118. Consequently, oncethe tabs 134 of retainer 124 are retracted into the device body 212, thefirst anastomotic component 118 is repelled by magnet 135 toward theouter surface of the vessel wall.

FIGS. 12A and 12B show the delivery device 110 after the actuator 122has been partially actuated to retract the tabs 134 and the anastomoticcomponent 118 has been repelled by the magnet 135. FIGS. 13A and 13Bshow the delivery device 110 after the actuator 122 has been furtheractuated to release the first and second anastomotic components 118, 120from the retainer 126 and allow the delivery device to be removed.

As shown best in FIG. 13A, the body 112 of the delivery device 110 has asloped surface 136, while the retainer 126 has a similarly shapedsurface 138. Moving the plunger 130 distally moves the retainer 126distally from the position shown in FIGS. 12A and 12B. This slides theramped surface 138 of the retainer 126 along the sloped surface 136 ofthe device body 112, which moves the retainer 126 laterally toward thecenter of the device 110 (to the right in FIG. 11A) and out ofengagement with the component 120 as well as the component 118.

FIGS. 14A and 14B illustrate in schematic fashion the principle behindone possible means for releasing the anastomotic components from thedelivery device according to the invention. A delivery device 140 has abody 142 provided with a bore 144 which slidably receives a plunger orshaft 146. The distal end of the device body 142 has a ramped surface148 configured to slide along a ramped surface 150 formed on a retainer152 carried by the plunger 146. FIG. 14A shows a magnetic anastomoticcomponent 154 mounted on the distal end of the delivery device body 142with the retainer 152 in its engaged position. As indicated by thearrow, the retainer 152 and the distal end of the delivery device body142 combine to securely engage the inner diameter of the anastomoticcomponent 154.

Actuation of the delivery device 140 moves the plunger 146 and retainer152 distally from the position of FIG. 14A to the position of FIG. 14B.This slides the ramped surface 150 on the retainer 152 along the rampedsurface 148 on the body 142 of the delivery device 140. Sliding theramped surface 150 along the surface 148 moves the retainer 152laterally (to the right in FIGS. 14A and 14B) and decreases its profileas indicated by the arrow. This disengages the retainer 152 from theinner diameter of the anastomotic component 154. It should beappreciated that the ramped surfaces shown in the illustrated embodimentrepresent only one possible way to transmit motion from an actuator tothe working end of the delivery device in order to form an anastomosisaccording to the invention

The magnetically attracted anastomotic components of the invention areadapted to be placed on opposite surfaces of a vessel wall and tosandwich the wall due to magnetic force. In some applications it may bedesirable to provide one or more of the anastomotic components withadditional or different vessel securing means; for example, thecomponent may be attached to the vessel mechanically (e.g. by suturing)instead of or in addition to magnetically. The suture could be passedaround the body of the anastomotic component and through the vesselwall, or the component could be provided with one or more sutureanchors, for example, at spaced locations around its perimeter. Thespecific number, size, and location of suture anchors on the anastomoticcomponent may of course vary depending on the application and userpreference.

Other features, aspects and advantages of the invention beyond thosespecifically discussed will be apparent to those skilled in the art.Many modifications, alterations and variations of the illustratedembodiments may be made without departing from the scope and spirit ofthe invention as defined by the claims.

1. A method for forming an anastomosis between first and second hollowbodies using magnetic force, the method comprising steps of: receivingfirst and second anastomotic components respectively configured to besecured to first and second hollow bodies, the first and secondcomponents being magnetically attracted to one another; mounting thefirst component on a delivery device; securing the second anastomoticcomponent to the second hollow body; mounting the second anastomoticcomponent on the delivery device with the second hollow body secured tothe second component; securing the first anastomotic component to thefirst hollow body; and using magnetism to couple the first and secondanastomotic components and form an anastomosis between the first andsecond hollow bodies.
 2. The method of claim 1, wherein the first andsecond hollow bodies are blood vessels.
 3. The method of claim 2,wherein the first component is mounted on the delivery device in acollapsed configuration.
 4. The method of claim 2, wherein the secondanastomotic component is magnetically mounted on the delivery device. 5.The method of claim 4, wherein the second anastomotic component ismounted on a ferromagnetic sheet supported by the delivery device. 6.The method of claim 5, wherein the ferromagnetic sheet is manipulated tomove the second anastomotic component into alignment with the firstanastomotic component.
 7. The method of claim 2, further comprisingforming an opening in the first blood vessel prior to securing the firstanastomotic component thereto.
 8. The method of claim 7, wherein theopening is formed by an incising element carried by the delivery device.9. The method of claim 2, wherein the delivery device has a cradle and aportion of the second hollow body is received in and supported by thecradle.
 10. The method of claim 2, wherein the first anastomoticcomponent has tabs received in slots formed in the delivery device. 11.The method of claim 2, wherein the first and second anastomoticcomponents are coupled to form a side-to-side anastomosis between thefirst and second blood vessels.
 12. A method for coupling first andsecond magnetically attracted anastomotic components mounted on adelivery device, the method comprising steps of: receiving first andsecond anastomotic components respectively configured to be secured tofirst and second hollow bodies, the first and second components beingmagnetically attracted to one another; providing a delivery deviceconfigured to support the first and second anastomotic components;mounting the first anastomotic component on the delivery device;mounting the second anastomotic component on the delivery device in afirst position; moving the second anastomotic component from the firstposition to a second position; and using magnetism to couple the firstand second anastomotic components.
 13. The method of claim 12, whereinthe delivery device has a transfer member holding the second anastomoticcomponent, and the moving step is performed by moving the transfermember and second anastomotic component from the first position towardthe first anastomotic component.
 14. The method of claim 13, wherein thetransfer member is moved until the first and second anastomoticcomponents are aligned, and then is moved further to release the secondanastomotic component from the delivery device.
 15. The method of claim14, wherein moving the transfer member further also releases the firstanastomotic component from the delivery device.
 16. The method of claim14, wherein moving the transfer member allows the first and secondanastomotic components to magnetically engage each other.
 17. The methodof claim 16, wherein the transfer member is moved to align and releasethe first and second anastomotic components.
 18. The method of claim 13,wherein the second anastomotic component is magnetically attracted tothe transfer member and is held in the first position by magnetic force.19. The method of claim 18, wherein the transfer member is a sheethaving ferromagnetic properties and the second anastomotic componentcomprises a permanent magnet attracted to the sheet.
 20. A method forbypassing a portion of a blood vessel using magnetism, the methodcomprising steps of: receiving first and second anastomotic componentsthat are magnetically attracted, respectively, to third and fourthanastomotic components; providing a graft vessel having a proximalportion adapted to be secured to a source of blood and a distal portionadapted to be secured to a target vessel so as to bypass a portion ofthe target vessel; securing the first anastomotic component to theproximal portion of the graft vessel and securing the second anastomoticcomponent to the distal portion of the graft vessel; securing the thirdanastomotic component to a source of blood and securing the fourthanastomotic component to the target vessel at a location distal to theportion to be bypassed; using magnetism to couple the first and thirdanastomotic components together and form a proximal anastomosis; andusing magnetism to couple the second and fourth anastomotic componentstogether to form a distal anastomosis, wherein the distal anastomosis isformed before the proximal anastomosis.
 21. The method of claim 20,wherein the blood source is the aorta and the target vessel is acoronary artery.
 22. The method of claim 21, wherein the first and thirdanastomotic components are coupled without entering the lumen of thegraft vessel.
 23. The method of claim 21, wherein the third anastomoticcomponent is secured to the aorta by a mechanical attachment.
 24. Themethod of claim 21, wherein the graft vessel is an autologous bloodvessel.
 25. A method for forming an anastomosis between first and secondhollow bodies using magnetic force, the method comprising steps of:positioning a first anastomotic component on a delivery device, thefirst anastomotic component adapted to be secured to a first hollowbody; positioning a second anastomotic component on the delivery device,the second anastomotic component adapted to be secured to a secondhollow body, wherein the first and second anastomotic components aremagnetically attracted to each other and are positioned on the deliverydevice in an offset configuration with respect to one another; securingthe second anastomotic component to a second hollow body so as to placethe opening of the second component in communication with the secondhollow body; moving the first and second anastomotic components from theoffset configuration into substantial alignment with each other; andusing magnetism to couple the first and second anastomotic componentsand form an anastomosis between the first and second hollow bodies. 26.The method of claim 25, wherein magnetic attraction between the deliverydevice and at least one of the first and second anastomotic componentsis used to move the components from the offset configuration.
 27. Amethod for coupling first and second magnetically attracted anastomoticcomponents, the method comprising steps of: receiving at least first andsecond anastomotic components configured to be secured to a first hollowbody, the first and second components being magnetically attracted toone another; providing a delivery device; mounting the first anastomoticcomponent on the delivery device; mounting the second anastomoticcomponent on the delivery device; and using magnetic repulsion between aportion of the delivery device and the first anastomotic component tomove the first anastomotic component toward the second anastomoticcomponent.
 28. The method of claim 27, wherein the delivery deviceincludes a permanent magnet oriented to repel the first anastomoticcomponent.
 29. The method of claim 27, wherein only the first and secondanastomotic components are mounted on the delivery device.